Can You Take Sleeping Pills While on Antidepressants?

Quick answer: sometimes, but only after your prescriber or pharmacist has checked the combination. Doctors do sometimes prescribe a sleep medicine, or a sedating antidepressant, alongside an existing antidepressant on purpose, but other combinations carry real risks: stacked drowsiness, a rare but serious reaction called serotonin syndrome, and complex sleep behaviours such as sleepwalking with some sleeping pills. So don’t add any sleep aid, including over-the-counter antihistamines, melatonin, herbal products like St John’s wort, or alcohol, until you have asked.

This guide is written to help you have that conversation. It explains the main types of sleep aid, the documented concerns with each, what to ask, and the warning signs that need help quickly. It does not give doses and is not a substitute for advice from the person who prescribes your medicine.

Who This Is For

You take an antidepressant and are sleeping badly, and you are wondering whether you can add something to help
You have a sleeping pill, antihistamine, melatonin or herbal remedy at home and want to know if it is safe with your medicine
Your doctor has suggested a sleep medicine or a second, sedating antidepressant and you want to understand the trade-offs
You are caring for an older relative who takes an antidepressant and has started using sleep aids

Quick Fix / Summary

Before taking anything for sleep, ask your prescriber or a pharmacist to check it against your antidepressant
Include over-the-counter products, melatonin, herbal remedies and supplements in that check, not just prescriptions
Avoid St John’s wort unless your prescriber has specifically agreed to it
Skip alcohol as a sleep aid while you are on these medicines
Ask about CBT-I (cognitive behavioural therapy for insomnia), the recommended first treatment for long-term insomnia
Learn the warning signs of serotonin syndrome and of complex sleep behaviours (listed below)
Never stop or change your antidepressant on your own to make room for a sleep aid

Why Antidepressants Can Affect Your Sleep in the First Place

Antidepressants can push sleep in either direction. The American Academy of Sleep Medicine (AASM) lists antidepressants among the medicines that can cause insomnia as a side effect, while the NHS lists feeling drowsy or very sleepy among possible antidepressant side effects. Some antidepressants are noticeably sedating: the NHS says mirtazapine can make you sleepy, which is why it is usually taken before bed.

That matters here for two reasons. First, if your sleep changed after you started or changed an antidepressant, the fix may be an adjustment your prescriber makes to the antidepressant itself, rather than an extra pill. Second, if your antidepressant already makes you drowsy, adding a sleep aid stacks one sedating effect on another. For a fuller picture of which antidepressants tend to cause insomnia, sleepiness or vivid dreams, see our guide to how antidepressants affect sleep and what helps.

Sleep Aids at a Glance: The Main Concern With Each

This table is a starting point for your conversation with a prescriber or pharmacist, not a list of what is safe. Each row is explained, with sources, further down.

Type of sleep aid	Examples	Main documented concern alongside an antidepressant
Z-drugs (prescription)	zolpidem, zopiclone, eszopiclone, zaleplon	Complex sleep behaviours (FDA boxed warning), next-day impairment, extra drowsiness
Benzodiazepines (prescription)	temazepam, diazepam	Extra drowsiness; listed as medicines to check with some antidepressants
Sedating antidepressants used for sleep (prescription)	trazodone, mirtazapine, doxepin	Added sedation; trazodone acts on serotonin, so serotonin syndrome is a consideration
Antihistamine sleep aids (over the counter)	diphenhydramine, promethazine	Extra drowsiness; not advised for most older adults; check with antidepressants
Melatonin	prescription-only in the UK; sold over the counter in some countries	Interacts with some antidepressants, such as fluvoxamine
Herbal and supplement products	St John’s wort, tryptophan, sedating herbal remedies	Serotonin syndrome risk with St John’s wort and tryptophan; extra drowsiness with sedating herbs
Alcohol	any	More drowsiness and dizziness; breathing problems with some sleeping pills

Prescription Sleeping Pills With Antidepressants: What Your Prescriber Weighs Up

There is no blanket rule against taking a prescribed sleeping pill with an antidepressant. Guidelines leave room for medicine when other approaches have not worked: the American College of Physicians (2016) recommends that, when CBT-I alone has not worked for chronic insomnia, the decision to add a sleep medicine is made jointly with the patient after discussing benefits, harms and costs. What a prescriber weighs is how the specific medicines fit together, how long you would take them, and your own risks.

Z-drugs: zolpidem, zopiclone, eszopiclone and zaleplon

In 2019 the US Food and Drug Administration (FDA) added a boxed warning, its most prominent warning, to eszopiclone, zaleplon and zolpidem after reports of serious injuries from complex sleep behaviours: sleepwalking, sleep driving and doing other activities while not fully awake. The FDA tells prescribers not to give these medicines to anyone who has had a complex sleep behaviour on them before, and tells patients to stop taking them if it happens. MedlinePlus lists examples such as driving, preparing and eating food, and making phone calls while not fully awake. The NHS lists the same kind of behaviour as a serious side effect of zopiclone, which is the Z-drug more often prescribed in the UK.

The FDA also warns that people can have reduced alertness the morning after taking an insomnia medicine, even if they feel fully awake. The NHS says zopiclone is usually prescribed for a few days to a few weeks, and usually not for more than 4 weeks, because the body can get used to it and it is possible to become addicted. If sleepwalking is already part of your history, tell your prescriber, and see our guide to sleepwalking in adults and how to stay safe.

Benzodiazepines

Benzodiazepines such as temazepam are an older type of sleeping pill. The NHS says GPs now rarely prescribe sleeping pills for insomnia, and when they do it is only for a few days, or weeks at most. NHS guidance on mirtazapine asks you to tell your doctor if you take medicines that relax your muscles, such as benzodiazepines, and NHS melatonin guidance names benzodiazepines such as temazepam and diazepam. Expect your prescriber to ask exactly what you take and when.

Over-the-Counter and “Natural” Sleep Aids: The Hidden Interaction Risks

Products you can buy without a prescription feel low-risk, which is exactly why they are easy to add without telling anyone. With an antidepressant on board, they are the combinations most worth checking.

Antihistamine sleep aids

Many pharmacy sleep aids are sedating antihistamines such as diphenhydramine or promethazine. MedlinePlus warns that diphenhydramine can make you drowsy, that alcohol adds to that drowsiness, and that it generally should not be used in older adults except for serious allergic reactions. NHS guidance on promethazine asks you to tell your doctor or pharmacist before taking it if you take any antidepressant, any other medicine for a mental health condition, or any medicine that makes you drowsy. The NHS insomnia page adds that pharmacy sleep products should not be taken for longer than 1 to 2 weeks and may leave you drowsy. The AASM’s 2017 guideline on sleep medicines (Sateia et al., Journal of Clinical Sleep Medicine) suggests doctors don’t use diphenhydramine to treat insomnia, a weak recommendation.

Melatonin

In the UK, melatonin is prescription-only and is mainly used for short-term sleep problems in people aged 55 and over. In some other countries it is sold as a supplement. Either way, NHS guidance on melatonin asks you to tell your doctor if you take antidepressants, naming fluvoxamine (an SSRI) and amitriptyline as examples, or Z-drugs or benzodiazepines for insomnia. It also says not to take herbal remedies that make you sleepy alongside melatonin, because they can make you much more drowsy. The AASM guideline also suggests doctors don’t use melatonin to treat insomnia (a weak recommendation).

St John’s wort

St John’s wort is a herbal remedy sometimes taken for low mood or sleep, and it is the clearest “don’t” in this article. The NHS says not to use St John’s wort with sertraline, and gives the same instruction for mirtazapine. The US National Center for Complementary and Integrative Health warns that taking it with certain antidepressants or other drugs that affect serotonin may lead to serotonin-related side effects that can be serious, and that it can weaken the effects of many important medicines. MedlinePlus also lists it as a product that may interact with zolpidem.

Tryptophan and other “serotonin” supplements

Some sleep and mood supplements contain tryptophan, a building block the body uses to make serotonin. An FDA-approved trazodone label says that using trazodone together with serotonin precursors such as tryptophan is not recommended. If a supplement label mentions tryptophan or serotonin, show it to your pharmacist before you take it.

Alcohol

Alcohol is not a sleep aid to rely on while you take an antidepressant. The NHS says alcohol can make your symptoms worse, or make you feel sleepy or dizzy, and the NHS zopiclone page warns that alcohol can increase that medicine’s effects and cause breathing problems. The FDA says not to drink alcohol before taking zolpidem, eszopiclone or zaleplon. Alcohol also tends to fragment sleep later in the night, as covered in how alcohol affects sleep quality.

Sedating Antidepressants Used for Insomnia

Some antidepressants make people drowsy enough that prescribers use that effect deliberately. The NHS advises taking trazodone at bedtime if you are having trouble sleeping, because it can make you sleepy, and mirtazapine is usually taken before bed for the same reason. A prescriber might choose one of these as your main antidepressant, or add one at bedtime to another antidepressant.

The evidence for using them purely as sleep medicines is mixed. The AASM 2017 guideline suggests doctors use doxepin, an older antidepressant, as an option for trouble staying asleep, but suggests they don’t use trazodone for insomnia. Both are weak recommendations, meaning the guideline panel was less certain about them. Two further points matter if a sedating antidepressant is added to the one you already take:

Sedation adds up. MedlinePlus warns that trazodone can make you drowsy and affect your judgement, thinking and movements, and that alcohol can make its side effects worse.
Serotonin is involved. MedlinePlus explains that trazodone works by increasing serotonin, and trazodone labelling includes a warning about serotonin syndrome, so combinations with other serotonin-affecting medicines are reviewed carefully. Your prescriber will weigh this, and you should know the symptoms (next section).

Choosing, adding or switching an antidepressant for sleep is a prescriber’s decision. Don’t take a spare supply of someone else’s medicine, or restart an old prescription, to help you sleep.

Serotonin Syndrome: The Combination Risk to Know About

MedlinePlus describes serotonin syndrome as a potentially life-threatening reaction that happens when medicines cause too much serotonin in the body. It is more likely when two or more serotonin-affecting medicines are combined, although the FDA notes it can also occur with one alone. MedlinePlus lists SSRIs such as sertraline, fluoxetine and citalopram, SNRIs such as venlafaxine and duloxetine, triptans for migraine, and the cough medicine dextromethorphan among the drugs involved. The NHS calls it rare but serious.

Symptoms usually appear within minutes to hours of taking the medicines involved. According to MedlinePlus and the NHS, they include:

Agitation, restlessness or confusion
A fast heartbeat and raised blood pressure
Sweating and a raised temperature
Shaking, twitching muscles, overactive reflexes or loss of coordination
Nausea, vomiting or diarrhoea

MedlinePlus advises contacting your healthcare provider right away if you have symptoms. If symptoms are severe, for example a very high temperature, severe confusion or a racing heart, call emergency services.

Older Adults: Falls, Memory and Next-Day Drowsiness

Age changes the balance of risk. The AASM notes that sleeping medicines can increase the risk of falling and affect memory. MedlinePlus says older adults should not usually take zolpidem, because it is not as safe or effective as other options, and gives similar advice for diphenhydramine. An older person who already feels drowsy or dizzy on an antidepressant is the person for whom an extra sleep aid deserves the most careful review, especially if they get up to use the toilet at night.

Next-day effects matter at any age. The FDA warns that alertness can be reduced the morning after an insomnia medicine even when you feel fully awake, and MedlinePlus advises not to drive or operate machinery until you know how diphenhydramine or trazodone affects you.

Non-Drug Options That Work Alongside Antidepressants

For insomnia that has lasted months, the first recommended treatment is not a pill. The American College of Physicians strongly recommends that all adults with chronic insomnia receive cognitive behavioural therapy for insomnia (CBT-I) as the initial treatment, and the AASM says CBT-I is recommended for chronic insomnia in adults. The NHS may also offer CBT for insomnia. CBT-I does not interact with your medicine, so it can run alongside your antidepressant.

CBT-I works on the habits and thoughts that keep insomnia going: a fixed wake time, limiting time awake in bed, and tackling worry about sleep itself. Our guide to how CBT-I works and how to access it covers the techniques. Because depression and sleep feed into each other, it also helps to read how depression and sleep affect each other, and our overview of what insomnia is and what helps if you are not sure whether your sleep problem counts as insomnia.

Questions to Ask Your Prescriber or Pharmacist

Bring a list of everything you take, including supplements, herbal teas and anything you buy at a pharmacy. Then ask:

Could my antidepressant, or its timing, be what is affecting my sleep, and is there an adjustment you would consider?
Is there anything for sleep that is safe to combine with my antidepressant, and anything I must avoid?
Is this sleep medicine meant for a few nights, a few weeks or longer, and how will we decide when to stop?
Does this combination raise my risk of serotonin syndrome, and what symptoms should I watch for?
Could it leave me drowsy the next day? When is it safe to drive?
I have sleepwalked (or a family member has). Does that change which medicine is suitable?
Can I be referred for CBT-I, or is there a digital CBT-I programme you recommend?
Who should I contact if my mood gets worse after a change?

Common Mistakes

Assuming “natural” means safe: St John’s wort and tryptophan are among the products linked to serotonin syndrome
Only mentioning prescriptions: pharmacists can only check what they know about, so include supplements and over-the-counter products
Using alcohol as a nightcap: it adds to drowsiness from antidepressants and some sleeping pills
Stopping the antidepressant to “make room” for a sleep aid: stopping suddenly can cause withdrawal symptoms, including sleep problems
Ignoring sleepwalking or sleep driving: on a Z-drug, one episode is a reason to stop it and call your prescriber, as the FDA advises
Letting a short course drift into months: most sleeping pills and pharmacy sleep aids are meant for short-term use

When to Get Help Urgently

Contact your prescriber, pharmacist or doctor straight away if you notice any of these after starting or combining medicines. If symptoms are severe, for example a very high temperature, severe confusion, a racing heart, or breathing problems or being very hard to wake, call 999 in the UK or 911 in the US.

Possible serotonin syndrome symptoms: agitation or confusion, a fast heartbeat, sweating, shaking or twitching muscles, a high temperature
Sleepwalking, sleep driving, or doing things at night you do not remember
Feeling so drowsy, dizzy or unsteady that you fall or nearly fall
Next-day drowsiness that affects driving, work or caring for others
New restlessness or leg discomfort at night after a medication change (see restless legs syndrome)
Night sweats that start after a medicine change (our guide to waking up sweating covers medication causes)

Mood is part of the safety picture. The NHS says some people have suicidal thoughts or an urge to self-harm when they start an antidepressant, and to speak to a doctor straight away if this happens. If your mood gets worse, or you have thoughts of harming yourself, get help now: in the US call or text 988 (Suicide & Crisis Lifeline), in the UK call 111 or Samaritans on 116 123, and if you are in immediate danger call 911 or 999.

FAQ

Can I take melatonin with an SSRI?

Check with your prescriber or pharmacist first. NHS guidance on melatonin asks you to tell your doctor if you take antidepressants, and names fluvoxamine (an SSRI) and amitriptyline as examples. That does not mean the combination is never used, but whether it suits you depends on which antidepressant you take and what else is in your routine.

Is it safe to take an over-the-counter sleep aid like diphenhydramine with an antidepressant?

Don’t assume it is. Antihistamine sleep aids add their own drowsiness, MedlinePlus says diphenhydramine generally should not be used by older adults, and the American Academy of Sleep Medicine suggests doctors don’t use it to treat insomnia. Ask a pharmacist to check it against your antidepressant before you try it, even once.

Can I take St John’s wort for sleep if I’m on an antidepressant?

No, not without your prescriber’s agreement. The NHS says not to use St John’s wort with sertraline or mirtazapine, and the US National Center for Complementary and Integrative Health warns that combining it with antidepressants can lead to serious serotonin-related side effects. It can also weaken many other medicines.

Why would a doctor prescribe a second antidepressant for sleep?

Some antidepressants, such as trazodone and mirtazapine, cause drowsiness, so the NHS advises taking them at bedtime and a prescriber may choose one partly for that effect. Because these medicines also act on serotonin or add sedation, the prescriber weighs the combination against everything else you take. It is a decision for them, not something to set up yourself.

Is it OK to have a drink to help me sleep while I’m on antidepressants?

It’s best not to. The NHS says alcohol can make depression symptoms worse or make you feel sleepy or dizzy when you take an antidepressant, and alcohol combined with sleeping pills such as zopiclone can cause breathing problems. Alcohol also tends to disrupt sleep later in the night.

Key Takeaways

Sleep aids and antidepressants are sometimes prescribed together on purpose, but the combination should always be checked by your prescriber or pharmacist
The main risks are stacked drowsiness, serotonin syndrome with serotonin-affecting products, and complex sleep behaviours with Z-drugs
Over-the-counter antihistamines, melatonin, St John’s wort, tryptophan and alcohol all need the same check as prescriptions
Older adults face extra risk of falls and memory problems from sleep medicines
CBT-I is the recommended first treatment for chronic insomnia and can be used alongside an antidepressant

About this article

Written by the Sleep Fixes editorial team. We’re not medical professionals. We research each topic against primary sources, here NHS medicines guidance, MedlinePlus, the US FDA, and published guidelines from the American College of Physicians and the American Academy of Sleep Medicine, and we hold ourselves to being critical and thorough about what actually makes it onto the site. Sources were checked in October 2026.

This article is part of Sleep Fixes, a site focused on practical, easy-to-follow solutions for common sleep problems like night waking, dry mouth, overheating, and disrupted sleep.

It is not medical advice and does not cover every medicine or interaction. Never start, stop or combine medicines, or change a dose, without talking to your prescriber or pharmacist. If your symptoms are severe, persistent, or worsening, contact a qualified healthcare professional.